Abstract
Retinopathy of prematurity (ROP) remains the main cause of visual impairment in preterm infants. The study was aimed to assess the impact of some of the risk factors (gestational age, body weight of children at birth, associated diseases in children, maternal age at delivery, maternal smoking during pregnancy, multiple pregnancies) on the occurrence of ROP in the sample of premature infants. We statistically processed the results (Student’s t test and the χ test) of 93 preterm infants of both sexes: 39 boys and 54 girls, examined by indirect ophthalmoscope (Haine 500, Germany) in mydriasis. The examination included all premature neonates with birth weight ≤ 2000g and/or gestational age ≤37 weeks, as well as neonates >37 weeks which have associated risk factors (oxygen, ventilation, sepsis, etc). Among 93 premature infants, with normal findings on the retina there were 72 children (77.42%), while in 21 (22.58%) children we found ROP. Ophthalmological findings: the first stage of ROP was found in 15.05%, the second stage of ROP in 2.15% and third stage of ROP in 5.38% of the examined children. There were no patients with an aggressive form of ROP. Children with ROP were statistically of lower gestational age 32.10 ± 2.70 compared to children without ROP 35.37 ± 1.72 (p<0.001). Children with ROP had at birth significant lower body weight of 1741g ± 579.19 than children without ROP 2168.75 ± 528.58 (p<0.01). Mothers of the children with ROP were, at the time of giving birth, over 29 ± 6.09 years old compared to mothers of children without ROP who were 26.42 ± 5.75 years old (p=0.0773). The presence of other diseases was significantly more prevalent in children with ROP 52.38% vs. 2.78% (p<0.001). The number of mothers of children with ROP who smoked during their pregnacy was considerable 57.14 % vs. 37.50% (percent of non-smoking mothers), though the difference was not statistically significant. Knowing the risk factors and their mechanisms of action requires a comprehensive approach to the complex problem of preventing prematurity, ROP, and appropriate ROP treatment. Acta Medica Medianae 2014;53(3):5-10.
Highlights
Retinopathy of prematurity (ROP) remains the main cause of visual impairment in former preterm infants [1]
The first phase begins with delayed retinal vascular growth after birth and partial regression of existing vessels, followed by a second phase of hypoxia-induced pathological vessel growth
The rising levels of Insulin-like growth factor 1 (IGF-1) in phase II of ROP allows vascular endothelial growth factor (VEGF) to stimulate the pathological neovascularization. These findings suggest that restoration of IGF-1 to normal levels might be useful in preventing ROP in preterm infants [6]
Summary
Retinopathy of prematurity (ROP) remains the main cause of visual impairment in former preterm infants [1]. Lack of IGF-1 in preterm infants prevents normal retinal vascular growth in phase I of ROP despite the presence of VEGF. The rising levels of IGF-1 in phase II of ROP allows VEGF to stimulate the pathological neovascularization These findings suggest that restoration of IGF-1 to normal levels might be useful in preventing ROP in preterm infants [6]. Stage 5 is the severest form of ROP, the final stage of the disease and the main cause of visual impairment and blindness This stage is a total retinal detachment in the shape of a funnel - stage 5A is an open funnel and stage 5B is a closed funnel. Other risk factors for ROP are concurrent illness [19], heart disease, infection, apnea, respiratory distress, bradycardia, white race, intraventricular hemorrhage, prolonged parenteral nutrition, lung maturation, steroid treatment, blood transfusions [10,19] and maternal factors such as preeclampsia, heavy smoker, older maternal age, multiple births, in vitro fertilization [19] etc
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